65 Pain Management Practices in the Elderly Patient with Burn Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S46-S47
Author(s):  
Ciara Hutchison ◽  
Rita Gayed ◽  
Rohit Mittal
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
Management Practices ◽  
Burn Injury ◽  
Management Strategies ◽  
Total Body Surface Area ◽  
Operative Therapy ◽  
The Elderly ◽  
Burn Patients ◽  
Opioid Use

Abstract Introduction Opioids are key to pain management in burns but have increased side effects like falls and delirium in the elderly. However, comorbidities prevalent in this population (e.g., chronic kidney disease) limit use of non-opioid adjuncts, making pain control for these patients a difficult balance. Little data exists regarding pain control practices in elderly burn patients. We aim to retrospectively characterize pain management strategies (including opioids and non-opioid adjuncts) in this patient population. Methods This is a retrospective cohort of patients age >65 with burns < 20% total body surface area (TBSA) admitted to the burn stepdown unit from 2014 to 2019. The primary outcome was to quantify opioid use inpatient and at discharge in morphine milligram equivalents (MME). Secondary outcomes included percent of patients receiving opioids and adjunct analgesics at these timepoints. Mean MME inpatient vs. at discharge were compared using paired t-test. Percent of patients receiving opioids and non-opioid adjuncts were compared using McNemar’s test. Results One hundred elderly patients (mean age 73.9, SD 6.7) with mean TBSA of 5.6% (SD 4.5) were included. Fifty-two percent required autografting; the remainder received porcine or non-operative therapy. Mean daily inpatient MME was 18.0 (SD 20.8) and mean discharge MME was 28.0 (SD 20.5) (p=.001), equivalent to 12mg and 18.5mg of oral oxycodone. Inpatient, 72% of patients received opioids vs. 83% at discharge (p=.041). Acetaminophen was the most commonly prescribed non-opioid adjunct inpatient and at discharge; other adjuncts like non-steroidal anti-inflammatories (NSAIDs) and gabanoids were infrequently used. Conclusions Elderly burn patients are discharged with more opioids than utilized while inpatient. Aside from acetaminophen, non-opioid adjuncts used commonly in younger patients such as NSAIDs and gabanoid medications are under-utilized, presumably due to concern for comorbidities.

scholarly journals A Review of Adjunctive Therapies for Burn Injury Pain During the Opioid Crisis

2019 ◽  
Vol 40 (6) ◽  
pp. 983-995 ◽  
Author(s):  
Daniel E Kim ◽  
Kaitlin A Pruskowski ◽  
Craig R Ainsworth ◽  
Hans R Linsenbardt ◽  
Julie A Rizzo ◽  
...  
Keyword(s):  
Pain Management ◽  
Randomized Controlled Trials ◽  
Systematic Reviews ◽  
Burn Injury ◽  
The United States ◽  
Pain Severity ◽  
Controlled Trials ◽  
Burn Patients ◽  
Opioid Use ◽  
Randomized Controlled

Abstract Opioids are the mainstay of pain management after burn injury. The United States currently faces an epidemic of opioid overuse and abuse, while simultaneously experiencing a nationwide shortage of intravenous narcotics. Adjunctive pain management therapies must be sought and utilized to reduce the use of opioids in burn care to prevent the long-term negative effects of these medications and to minimize the dependence on opioids for analgesia. The purpose of this review was to identify literature on adjunctive pain management therapies that have been demonstrated to reduce pain severity or opioid consumption in adult burn patients. Three databases were searched for prospective studies, randomized controlled trials, and systematic reviews that evaluated adjunctive pain management strategies published between 2008 and 2019 in adult burn patients. Forty-six studies were analyzed, including 24 randomized controlled trials, six crossover trials, and 10 systematic reviews. Various adjunctive pain management therapies showed statistically significant reduction in pain severity. Only one randomized controlled trial on music therapy for acute background pain showed a reduction in opioid use. One cohort study on hypnosis demonstrated reduced opioid use compared with historical controls. We recommend the development of individualized analgesic regimens with the incorporation of adjunctive therapies in order to improve burn pain management in the midst of an abuse crisis and concomitant national opioid shortage.

580 Assessing Opioid Use After Discharge in Pediatric Burn Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S141-S142
Author(s):  
Victoria Owens ◽  
Kathleen S Romanowski ◽  
Tina L Palmieri ◽  
David G Greenhalgh ◽  
Soman Sen
Keyword(s):  
Burn Injury ◽  
Total Body Surface Area ◽  
Outpatient Setting ◽  
Prescription Opioid ◽  
Burn Patients ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Mean Values ◽  
Pain Scores

Abstract Introduction Opioids are frequently prescribed after burn injury. Prolonged use of opioids can increase dependence and potential for life threatening complications. For burn-injured children, optimizing opioid prescriptions in the outpatient setting can reduce these risks. Our aim for this study was to assess and analyze the outpatient opioid prescription use in children with burn injuries. Methods After approval from the institutional review board, pediatric patients admitted to our institution with £20% total body surface area (TBSA) burn were included. Data collected included age, gender, % TBSA burn, mechanism of injury, length of stay, surgical procedures, total morphine milligram equivalent (MME) given in last 24 hours prior to discharge and discharge pain prescriptions. 7 days after discharge, families tracked and provided daily usage of prescription opioids, acetaminophen, and ibuprofen, as well as daily pain scores. Families were given a follow up questionnaire about whether a prescription opioid was prescribed and filled, daily medication needs, pain scores, storage of opioids, quantity of medications remaining, and disposal of any remaining opioids. All mean values are mean±standard deviation, all median values are median(interquartile range). Results Twenty-nine patients were enrolled with a mean age of 7±5.8 years and mean TBSA of 10±6%. Daily outpatient pain scores ranged from 0–2. 18 patients underwent skin graft surgery (SUR) and 11 did not (NOSUR). The mean % of opioids that were not used was 50%±38% and 52% of families kept the left-over opioids for future use. For the SUR group, a median % of opioids that were not used was 64(14–90)% and for the NOSUR the median was 35(17.5–56)% and 56% of SUR families and 45% of NOSUR families kept the left-over opioids for future use. Conclusions For pediatric burn patients, opioids prescribed at discharge may be overestimating pain needs. In our study, half of the opioids were not used, and this was even more pronounced in patients who underwent surgery. More concerning is that the majority of families did not dispose the opioids and instead kept the medication for future use. We recommend optimizing opioid prescribing practices to reduce over-prescribing opioids to burn injured children and educating families on the need for proper disposal of left-over opioids.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

scholarly journals Medically Treated Opioid Overdoses Among the U.S. Elderly: Trends and Correlates

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-54
Author(s):  
Peter Treitler ◽  
Stephen Crystal ◽  
Richard Hermida ◽  
Jennifer Miles
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
The Elderly ◽  
Opioid Use Disorder ◽  
Chronic Obstructive ◽  
Medicare Beneficiaries ◽  
Older Individuals ◽  
Opioid Use ◽  
Policy And Practice ◽  
Obstructive Pulmonary Disease

Abstract High rates of opioid prescribing and comorbid medical conditions increase risk of overdose among older adults. As the US population ages and the rates of opioid use disorder (OUD) increase in the elderly population, there is a need to characterize trends and correlates of overdose in order to more effectively target policy and practice. Using a ~40% random sample of 2015-2017 Medicare beneficiaries ages 65 and older with Part D pharmacy coverage, this study examined medically treated opioid overdoses among US older adults. The sample included 13-14 million beneficiaries per year. The rate of medically treated opioid overdoses among elderly Medicare beneficiaries increased by 15% from 6 per 10,000 in 2015 to 6.9 per 10,000 in 2017. Those with overdose were disproportionately female (63%), non-Hispanic white (83%), with diagnoses of pain conditions (96%), with diagnoses of major depression (63%), and with high rates of conditions that decrease respiratory reserve such as chronic obstructive pulmonary disease. 13% had co-occurring diagnosed alcohol use disorder, 36% were diagnosed with opioid dependence or abuse, and 12% were diagnosed with hepatitis C. Older individuals with overdose represent a complex mix of risk factors; identifying those most at risk (as well as those who have very low risk, whose pain management may be compromised by overly-rigid interpretation of opioid use guidelines) is key in order to address multiple risks, balancing risk reduction with appropriate pain management.

scholarly journals International survey: real-world pain management strategies

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Hagen ◽  
A Georgescu
Keyword(s):  
Pain Management ◽  
Real World ◽  
Pain Control ◽  
Online Survey ◽  
Management Strategies ◽  
Pain Medication ◽  
International Survey ◽  
Nationally Representative ◽  
Online Panels ◽  
Control Pain

Abstract Background Pain is a nearly universal experience, but little is known about how people treat pain. This international survey assessed real-world pain management strategies. Methods From 13-31 January, 2020, an online survey funded by GSK Consumer Healthcare was conducted in local languages in Australia, Brazil, Canada, China, Colombia, France, Germany, India, Italy, Japan, Saudi Arabia, Malaysia, Mexico, Poland, Russia, Spain, Sweden, UK, and USA. Adults were recruited from online panels of people who agreed to participate in surveys. Quotas ensured nationally representative online populations based on age, gender, and region. Results Of 19,000 people (1000/country) who completed the survey, 18,602 (98%) had ever experienced physical pain; 76% said they would like to control their pain better. Presented with 17 pain-management strategies and asked to select the ones they use in the order of use, respondents chose an average of 4 strategies each. The most commonly selected strategies were pain medication (65%), rest/sleep (54%), consult a doctor (31%), physical therapy (31%), and nonpharmacologic action (eg, heat/cold application; 29%). Of those who use pain medication, 56% take some other action first. Only 36% of those who treat pain do so immediately; 56% first wait to see if it will resolve spontaneously. Top reasons for waiting include a desire to avoid medication (37%); willingness to tolerate less severe pain (33%); concerns about side effects (21%) or dependency (21%); and wanting to avoid a doctor's visit unless pain is severe or persistent (21%). Nearly half (42%) of those who take action to control pain have visited ≥1 healthcare professional (doctor 31%; pharmacist 18%; other 17%) about pain. Conclusions This large global survey shows that people employ a range of strategies to manage pain but still wish for better pain control. Although pain medication is the most commonly used strategy, many people postpone or avoid its use. Key messages More than three-quarters (76%) of respondents across countries seek better pain control. Pain medication and rest/sleep consultation are the most common pain management strategies. More than half of respondents (56%) wait to see if pain will resolve spontaneously before taking any action, and 56% of those who use pain medication try some other approach first.

scholarly journals A Comparative Study between C-Reactive Protein and Procalcitonin in Iraqi Burn Patients

2017 ◽  
Vol 28 (1) ◽  
pp. 41
Author(s):  
Alia E. Al-Ubadi
Keyword(s):  
Burn Injury ◽  
Total Body Surface Area ◽  
Latex Agglutination ◽  
Burn Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Survivor Group ◽  
Significant Difference ◽  
The Mean ◽  
Total Body

Association between Procalcitonin (PCT) and C-reactive protein (CRP) and burn injury was evaluated in 80 burned patients from Al-Kindy and Imam Ali hospitals in Baghdad-Iraq. Patients were divided into two groups, survivor group 56 (70%) and non-survivor group 24 (30%). PCT was estimated using (Human Procalcitonin ELISA kit) provided by RayBio/USA while CRP was performed using a latex agglutination kit from Chromatest (Spain). Our results declared that the mean of Total Body Surface Area (TBSA %) affected were 63.5% range (36%–95%) in non-survivor patients, while 26.5% range (10%–70%) in survivor patients. There is a significant difference between the two groups (P = 0.00), the higher mean percentage of TBSA has a significant association with mortality. Serum PCT and CRP were measured at the three times of sampling (within the first 48hr following admission, after 5thdays and after 10th days). The mean of PCT serum concentrations in non-survivor group (2638 ± 3013pg/ml) were higher than that of survivor group (588 ± 364pg/ml). Significantly high levels of CRP were found between the survivor and non-survivor groups especially in the 10th day of admission P=0.000, present study show that significant differences is found within the non-survivor group through the three times P= 0.01, while results were near to significant differences within survivor group through the three times (P= 0.05).

A Quality Improvement Project on Pain Management at a Tertiary Pediatric Hospital

2021 ◽  
pp. 084456212110477
Author(s):  
Jodi Wilding ◽  
Hailey Scott ◽  
Victoria Suwalska ◽  
Zarina Geddes ◽  
Carolina Lavin Venegas ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Management ◽  
Chart Review ◽  
Management Practices ◽  
Pain Treatment ◽  
Management Strategies ◽  
Improvement Project ◽  
Pain Scores ◽  
Health Quality ◽  
T1 And T2

To assess and improve pain management practices for hospitalized children in an urban tertiary pediatric teaching hospital. Methods Health Quality Ontario Quality Improvement (QI) framework informed this study. A pre (T1) – post (T2) intervention assessment included chart reviews and children/caregiver surveys to ascertain pain management practices. Information on self-reported pain intensity, painful procedures, pain treatment and satisfaction were obtained from children/caregivers. Documented pain assessment, pain scores, and pharmacological/non-pharmacological pain treatments were collected by chart review. T1 data was fed back to pediatric units to inform their decisions and pain management targets. Results At T1, 51 (58% of eligible participants) children/caregivers participated. At T2, 86 (97%) chart reviews and 51 (54%) children/caregivers surveys were completed. Most children/caregivers at T1 (78%) and T2 (80%) reported moderate to severe pain during their hospitalization. A mean of 2.6 painful procedures were documented in the previous 24 h, with the most common being needle-related procedures at both T1 and T2. Pain management strategies were infrequently used during needle-related procedures at both time points. Conclusion No improvements in pain management as measured by the T1 and T2 data occurred. Findings informed further pain management initiatives in the participating hospital.

scholarly journals Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Matthew Pate ◽  
Jacob Hall ◽  
John Anderson ◽  
Donald Bohay ◽  
John Maskill ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Ankle Fracture ◽  
Management Practices ◽  
Opioid Analgesic ◽  
The United States ◽  
Ankle Fractures ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Medication

Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.

Pain Management for Pediatric Burns in the Outpatient Setting: A Changing Paradigm?

2020 ◽  
Vol 41 (4) ◽  
pp. 814-819
Author(s):  
Niti Shahi ◽  
Maxene Meier ◽  
Ryan Phillips ◽  
Gabrielle Shirek ◽  
Adam Goldsmith ◽  
...  
Keyword(s):  
Pain Control ◽  
Multimodal Therapy ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Medication Use ◽  
Pain Medication ◽  
Outpatient Setting ◽  
Burn Injuries ◽  
Opioid Prescription ◽  
Over The Counter

Abstract Childhood burns are common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, which can negatively influence the child’s care and increase the risk of posttraumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of pediatric outpatient burns. We sought to evaluate the current use of opioids (including the use of multimodal therapies), storage, and disposal of opioids in this patient population. Parents of burn-injured children 8 months to 18 years old, who were seen in an outpatient setting within 2 weeks of their burn injury, were queried from April to December 2019 regarding their child’s pain control, opioid medication use, over-the-counter pain medication use, opioid storage, and disposal. A total of 142 parents of burn-injured children and their parents were surveyed. The median age of the burn-injured children was 2.7 years old and the majority (54.2%; 77/142) were male. The mean total body surface area (TBSA) was 1.8% and half sustained burn injuries to one or both hands. The most frequently used regimens for constant and/or breakthrough pain control were acetaminophen (62.7%) and nonsteroidal anti-inflammatory drugs (NSAIDs; 68.3%). Less than one fifth (26/142;18%) of patients were prescribed opioids and 88% filled their prescription. The median number of doses of opioids prescribed was eight doses, with a median of four doses of opioids unused. Only three patients used all of their prescribed opioids and no patient ≥12 years old used their entire prescription. Burns greater than 3% TBSA, irrespective of burn injury location, were associated with opioid prescription (P = .003). Approximately 40% (10/26) of parents who filled their child’s opioid prescription stored the opioid in a locked area. Fewer than one third (7/26) of patients were educated on how to dispose of excess opioid pain medication. Overall, most pediatric outpatient burn injuries can be successfully managed with over-the-counter medications. Providers, who care for burn-injured children ≤ 12 years old with burns that cover ≥3% TBSA in the outpatient setting, should consider no more than four opioid doses for initial pain control. This guideline, coupled with family and provider-centered education on multimodal therapy at the time of initial presentation and safe use of opioids, are important first steps to minimizing the use of opioids in the management of small area burns in children.

664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S177-S177
Author(s):  
Kate Pape ◽  
Sarah Zavala ◽  
Rita Gayed ◽  
Melissa Reger ◽  
Kendrea Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Pediatric Patients ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Future Research ◽  
Burn Patients ◽  
Thermal Burn ◽  
Increased Risk ◽  
Significant Difference

Abstract Introduction Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy. Methods This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] > 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST. Results A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality. Conclusions Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis. Applicability of Research to Practice Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.

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